BFIS-LF: Self-Report

Screening Visit

How much difficulty do you have functioning effectively in each of these major life activities? That is, to what degree do you see yourself as being impaired in each of these life domains? Please indicate the number next to each item that best describes your difficulties in functioning DURING THE PAST 6 MONTHS with 0 meaning "not at all" and 9 meaning "severely impaired". If the situation does not apply to you (for instance, you don't drive a car, don't have children, don't live with anyone, etc.), indicate 888.